What Have We Been Getting Wrong About Back Pain?

Back pain is one of the most common medical complaints, and it’s increasing in prevalence year on year. While our desk-bound lifestyles are certainly a large factor in this increase, misconceptions amongst both the general population and medical professionals means that back pain often isn’t being treated or managed correctly.

We look for all the answers in MRI scans

People with back pain will often be given or insist on an MRI scan, a type of imaging that is able to reveal structural problems in the spine. Many physicians will then focus on resolving these problems or managing them, while the patient becomes very concerned with what are very scary-sounding conditions such as disc degeneration or disc bulges.

However, if they had scanned someone without back pain, it’s very likely they would have found the same results under imaging. Studies where healthy, symptom-free people receive MRIs have shown that your average 50 year old has an 80% chance of showing disc degeneration and a 60% of showing a disc bulge.

Like any medical condition, a correlation can be easily confused with the cause. While disc degeneration or a disc bulge can sometimes be the cause of pain, we know that it often isn’t. In fact, only around of 5% of lower back pain can be explained by such deep structural issues.

If structural issues in the spine are to blame for our aching backs, how are so many people living with degenerated and bulging discs without any issue? Clearly, there are others factors in play, and everything from stress and depression to your work chair or lack of activity are far more likely to be responsible.

We protect our spines too much

You often hear of broken limbs and sprained joints, but acute spinal injuries are very rare. Most of the time, if someone has developed back pain, it’s developed slowly without any sudden trauma. This is because the spine is far stronger than most people give it credit, able to carry enormous loads while still being incredibly flexible.

Yet people don’t think of their spines this way. Perhaps because of the prevalence of back pain, many see the spine as a weak and vulnerable part of the body, leading to overprotection of the spinal structures when we really need to be strengthening them like we would any other muscle or ligament.

Think of how much attention is put on core stability when exercising, when the spine is more than capable of taking much of the load that we’re instead directing to the opposite side of the body. This is like training your tricep when you’re trying to strengthen your bicep; clearly ineffective, yet when it comes to the spine, this approach is widely accepted.

This means that even fit and active people underutilise their lower back muscles, leading to weakness and a build up of fatty deposits in the tissue. As you’d expect, this can lead to pain, but then what do they do? They avoid using their back even more! This easily leads to the same cycle of weakness and pain that can affect any muscle, yet with the lower back, blame gets placed elsewhere.

We’re obsessed with “good posture”

How many times have you been told to “sit up straight” in your life? Whether it was your parents, your teachers or your boss, chances are this instruction’s been drilled into you for years. But is it any good for you?

While there is a sitting posture that puts your spine into a neutral position (lumbar slightly curved, shoulders parallel, chin slightly tucked), holding this position for too long is still bad for you. That 90 degree angle that’s pushed as good posture eventually leads to tight hip flexors, which connect to your lower back – so by trying to look after your back, you may only make it worse.

Studies have even suggested that a slouchier, leaned-back position with the legs extended is better for you, because it takes load off your lower back and opens up your hips.

So what’s a good sitting posture? Well, there isn’t one, really. Staying still for too long is going to result in muscles and ligaments either lengthened or shortened more than they should be, leading to imbalances, tensions, sprains and even injury. Our bodies are made to move, not be stuck in a desk all day, so instead of sitting bolt upright for hours on end, rotate through a bunch of different postures and get up and walk around as much as you can.

Luckily, physiotherapists and other medical professionals are starting to address the longstanding failures in treating and managing back pain. Peter O’Sullivan, a world-renowned expert in the field, recently held a three day course on his highly effective and trend-bucking treatment approach called cognitive functional therapy. I was lucky enough to attend, and wrote about it here.

If you have any questions about back pain or would like to book an appointment, feel free to get in touch with me at enquiries@physiolondon.co.uk or call us on 020 7093 3499.

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He took time to assess the problem, discussed with me various way of improving the condition and showed me in detail exercises I could do at home.
Very positive experience from the reception lady to the specialist.
Highly recommended.

My physiotherapist Candice is fab. I can't say enough great things about her and her professionalism. After suffering a trapped nerve and extremely painful scapula for nearly 8 weeks all the NHS would offer me was strong drugs, I was at my wit's end. I saw Candice, she gave me a comprehensive medical diagnosis as to what was causing the problem and has offered to refer me back into the NHS should a set schedule of regular treatments not rectify the problem.
I was dubious about going privately for treatment as money is tight, but this organisation seems to want to help. There is not a schedule of endless appointments and the prices are reasonable. The condition is improving slowly and I feel better in myself knowing what caused it and that I am in safe hands going forward.
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I have used Physiotherapy London at their Westferry studio on and off for several years and for various (never serious) reasons. I have always found them to be knowledgeable and professional in their approach, and they do not drag out and prolong the treatment beyond what is necessary. I am being treated by Mani at present for a problem with my wrists and have to say that he is just a bit exceptional. So approachable and kind.
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